US20110208180A1 - System and Method for Monitoring Ablation Size - Google Patents
System and Method for Monitoring Ablation Size Download PDFInfo
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- US20110208180A1 US20110208180A1 US12/712,864 US71286410A US2011208180A1 US 20110208180 A1 US20110208180 A1 US 20110208180A1 US 71286410 A US71286410 A US 71286410A US 2011208180 A1 US2011208180 A1 US 2011208180A1
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- microwave antenna
- tissue
- thermal sensors
- ablation zone
- power source
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00084—Temperature
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00084—Temperature
- A61B2017/00101—Temperature using an array of thermosensors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
- A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
- A61B2018/00023—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids closed, i.e. without wound contact by the fluid
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00666—Sensing and controlling the application of energy using a threshold value
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
- A61B2018/1869—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves with an instrument interstitially inserted into the body, e.g. needles
Definitions
- the present disclosure relates to systems and methods that may be used in tissue ablation procedures. More particularly, the present disclosure relates to systems and methods for monitoring ablation size during tissue ablation procedures in real-time.
- Microwave ablation procedures e.g., such as those performed for menorrhagia, are typically done to ablate the targeted tissue to denature or kill the tissue.
- Many procedures and types of devices utilizing electromagnetic radiation therapy are known in the art.
- Such microwave therapy is typically used in the treatment of tissue and organs such as the prostate, heart, and liver.
- One non-invasive procedure generally involves the treatment of tissue (e.g., a tumor) underlying the skin via the use of microwave energy.
- tissue e.g., a tumor
- the microwave energy is able to non-invasively penetrate the skin to reach the underlying tissue.
- this non-invasive procedure may result in the unwanted heating of healthy tissue.
- the non-invasive use of microwave energy requires a great deal of control.
- one or more types of sensors are operably associated with the microwave ablation device.
- a microwave ablation device that includes a monopole antenna configuration
- an elongated microwave conductor may be in operative communication with a sensor exposed at an end of the microwave conductor. This type of sensor is sometimes surrounded by a dielectric sleeve.
- the foregoing types of sensor(s) is configured to function (e.g., provide feedback to a controller for controlling the power output of a power source) when the microwave ablation device is inactive, i.e., not radiating. That is the foregoing sensors do not function in real-time.
- the power source is powered off or pulsed off when the sensors are providing feedback (e.g., tissue temperature) to the controller and/or other device(s) configured to control the power source.
- the present disclosure provides a system for monitoring ablation size in real-time.
- the system includes a power source including a microprocessor for executing at least one control algorithm.
- a microwave antenna is configured to deliver microwave energy from the power source to tissue to form an ablation zone.
- a series of thermal sensors is operably disposed adjacent a radiating section of the microwave antenna and extends proximally therefrom. The thermal sensors corresponding to a radius of the ablation zone, wherein each thermal sensor generates a voltage when a predetermined threshold tissue temperature is reached corresponding to the radius of the ablation zone.
- the present disclosure provides a microwave antenna adapted to connect to a power source configured for performing an ablation procedure.
- the microwave antenna includes a radiating section configured to deliver microwave energy from the power source to tissue to form an ablation zone.
- the microwave antenna includes a series of thermal sensors operably disposed adjacent the radiating section of the microwave antenna and extending proximally therefrom. The thermal sensors corresponding to a radius of the ablation zone, wherein each thermal sensor generates a voltage when a predetermined threshold tissue temperature is reached corresponding to the radius of the ablation zone.
- the present disclosure also provides a method for monitoring temperature of tissue undergoing ablation.
- the method includes the initial step of transmitting microwave energy from a power source to a microwave antenna to form a tissue ablation zone.
- a step of the method includes monitoring the proximal propagation of tissue temperature along the microwave antenna as the tissue ablation zone forms.
- Triggering a detection signal when a predetermined tissue temperature is reached at specific points along the microwave antenna is another step of the method.
- the method includes adjusting the amount of microwave energy from the power source to the microwave antenna.
- FIG. 1A is a perspective view of a system for monitoring ablation size according to an embodiment of the present disclosure
- FIG. 1B is a perspective view of a system for monitoring ablation size according to another embodiment of the present disclosure.
- FIG. 2A is partial side view of a distal tip of a microwave antenna depicted in FIG. 1A ;
- FIG. 2B is partial side view illustrating internal components associated with a distal tip of a microwave antenna according to an alternate embodiment of the present disclosure
- FIG. 3A is a schematic, plan view of the tip of a microwave antenna depicted in FIG. 2A illustrating radial ablation zones having a spherical configuration
- FIG. 3B is a schematic, plan view of the tip of a microwave antenna depicted in FIG. 2A illustrating radial ablation zones having an ellipsoidal configuration
- FIG. 4 is a functional block diagram of a power source for use with the system depicted in FIG. 1A ;
- FIG. 5 is a flow chart illustrating a method for monitoring temperature of tissue undergoing ablation in accordance with the present disclosure.
- distal refers to the portion which is furthest from the user and the term “proximal” refers to the portion that is closest to the user.
- proximal refers to the portion that is closest to the user.
- terms such as “above”, “below”, “forward”, “rearward”, etc. refer to the orientation of the figures or the direction of components and are simply used for convenience of description.
- the system 10 includes a microwave antenna 100 that is adapted to connect to an electrosurgical power source, e.g., an RF and/or microwave (MW) generator 200 that includes or is in operative communication with one or more controllers 300 and, in some instances, a fluid supply pump 40 .
- an electrosurgical power source e.g., an RF and/or microwave (MW) generator 200 that includes or is in operative communication with one or more controllers 300 and, in some instances, a fluid supply pump 40 .
- MW radio frequency and/or microwave
- microwave antenna 100 includes an introducer 116 having an elongated shaft 112 and a radiating or conductive section or tip 114 operably disposed within elongated shaft 112 , a cooling assembly 120 having a cooling sheath 121 , a handle 118 , a cooling fluid supply 122 and a cooling fluid return 124 , and an electrosurgical energy connector 126 .
- Connector 126 is configured to connect the microwave antenna 100 to the electrosurgical power source 200 , e.g., a generator or source of radio frequency energy and/or microwave energy, and supplies electrosurgical energy to the distal portion of the microwave antenna 100 .
- the electrosurgical power source 200 e.g., a generator or source of radio frequency energy and/or microwave energy
- Conductive tip 114 and elongated shaft 112 are in electrical communication with connector 126 via an internal coaxial cable 126 a that extends from the proximal end of the microwave antenna 100 and includes an inner conductor tip that is operatively coupled to a radiating section 138 operably disposed within the shaft 112 and adjacent the conductive or radiating tip 114 (see FIG. 2A , for example).
- internal coaxial cable 126 a includes a dielectric material and an outer conductor surrounding each of the inner conductor tip and dielectric material.
- a connection hub (not shown) disposed at a proximal end of the microwave antenna 100 operably couples connector 126 to internal coaxial cable 126 a , and cooling fluid supply 122 and a cooling fluid return 124 to a cooling assembly 120 .
- Radiating section 138 by way of conductive tip 114 is configured to deliver radio frequency energy (in either a bipolar or monopolar mode) or microwave energy to a target tissue site.
- Elongated shaft 112 and conductive tip 114 may be formed of suitable conductive material including, but not limited to copper, gold, silver or other conductive metals having similar conductivity values.
- elongated shaft 112 and/or conductive tip 114 may be constructed from stainless steel or may be plated with other materials, e.g., other conductive materials, such as gold or silver, to improve certain properties, e.g., to improve conductivity, decrease energy loss, etc.
- the conductive tip may be deployable from the elongated shaft 112 .
- system 10 may be configured for use with a microwave antenna 512 illustrated in FIG. 1A .
- microwave antenna 512 operably couples to generator 200 including a controller 300 via a flexible coaxial cable 516 .
- generator 200 is configured to provide microwave energy at an operational frequency from about 500 MHz to about 10 GHz.
- Microwave antenna 512 includes a radiating section or portion 518 that may be connected by a feedline or shaft 520 to coaxial cable 516 that extends from the proximal end of the microwave antenna 512 and includes an inner conductor operably disposed within the shaft 520 and adjacent radiating section 518 and/or a conductive or radiating tissue piercing tip 524 .
- the microwave antenna 512 is coupled to the cable 516 through a connection hub 522 .
- the connection hub 522 also includes an outlet fluid port 530 (similar to that of cooling fluid return 124 ) and an inlet fluid port 532 (similar to that of cooling fluid supply 122 ) that are connected in fluid communication with a sheath 538 .
- the sheath 538 encloses the radiating portion 518 and the shaft 520 allowing for coolant fluid from the ports 530 and 532 to be supplied to and circulated around the antenna assembly 512 via respective fluid lumens 530 a and 532 a .
- the ports 530 and 532 may also couple to supply pump 40 .
- microwave antenna 100 For the remainder of the disclosure the operative components associated with the system 10 are described with reference to microwave antenna 100 .
- thermal sensor 136 is operably disposed along a length of the shaft 112 adjacent a radiating section 138 of the microwave antenna 100 .
- thermal sensor 136 includes a series of six thermal sensors labeled 136 a - 136 f (collectively referred to as thermal sensors 136 ).
- a series of thermal sensors is meant to mean at least two thermal sensors.
- Thermal sensors 136 enable physical space sampling of the ablation site.
- Thermal sensors 136 may be operably positioned within an internal portion 150 of the shaft 112 .
- the thermal sensors 136 are operably disposed within an internal generally circumferential wall 152 that surrounds and/or defines the cooling fluid supply and fluid return lines 122 and 124 , see FIG. 2A , for example.
- Thermal sensors 136 may be secured to the circumferential wall 152 via any suitable methods.
- the thermal sensors 136 are secured to the circumferential wall via an epoxy adhesive.
- a plastic or other suitable structure provides mechanical fixation points for the thermal sensors 136 .
- the plastic structure e.g., a circumferential or spiral plastic structure
- the plastic structure may be operably disposed within the shaft 112 and couple to one or both of the fluid paths, e.g., supply fluid and return paths 122 and 124 .
- Thermal sensors 136 may be disposed along the length of the shaft 112 in any suitable configuration.
- thermal sensors 136 are positioned along the shaft 110 in a linear manner forming a generally linear array along circumferential wall 152 of the shaft 112 .
- the thermal sensors 136 may be positioned along circumferential wall 152 of the shaft 112 in a radially offset configuration forming a generally spherical or spiral array ( FIG. 2B ).
- Thermal sensors 136 may be any suitable thermal sensors 136 including but not limited to thermistors, thermocouples, fiber optic sensors, or other device suitable for the intended purpose for monitoring temperature. In the embodiment illustrated in FIGS.
- the thermal sensors 136 are six thermocouples 136 a - 136 f .
- Thermal sensors 136 are in operative communication with a temperature module 332 and/or controller 300 . More particularly, the thermal sensors 136 couple to the generator 200 and/or controller 300 via one or more leads, e.g., the internal cable 126 a that extends from the proximal end of the microwave antenna 100 and connects to the port 126 . In embodiments, the thermal sensors 136 may be in operative communication with the generator 200 and/or controller 300 by way of a wireless connection. Thermal sensors 136 are configured to provide comprehensive monitoring of an ablation zone “A” ( FIG. 3A ).
- the thermal sensors 136 are configured to generate an analog response (e.g., a voltage, resistance, current, etc.) when a predetermined threshold temperature is reached within the ablation zone “A.” More particularly, an initial voltage potential is generated by each of the thermal sensors 136 during transmission of electrosurgical energy from the generator 200 to the microwave antenna 100 .
- a predetermined threshold voltage potential is associated with each of thermal sensors 136 and corresponds to a predetermined threshold tissue temperature along a radius of an ablation zone ( FIG. 3A ).
- thermal sensor 136 a may be configured to generate an initial voltage potential of 1 volt and a predetermined threshold voltage of 2 volts that corresponds to a threshold tissue temperature of 60° Celsius that corresponds to an ablation zone “A” having a radius r 1 .
- the analog response indicates to temperature module 332 that a predetermined threshold temperature is reached at the ablation zone (described in more detail below). More particularly, temperature module 332 monitors the thermal sensors 136 , e.g., monitors voltage of the thermal sensors 136 , and triggers a command signal in response to the thermal sensors 136 reaching a predetermined voltage such that the electrosurgical output power from the generator 200 may be adjusted. In an embodiment, an amplifier (not shown) may be utilized to amplify the voltage potential generated by the thermal sensors 136 .
- each of the thermal sensors 136 may be configured to generate an analog response, e.g., a predetermined voltage, when a predetermined threshold temperature, e.g., a threshold temperature approximately equal to 60° Celsius, has been met such that an ablation zone “A” having a radius r is created.
- a predetermined threshold temperature e.g., a threshold temperature approximately equal to 60° Celsius
- the predetermined threshold temperature associated with a corresponding thermal sensor 136 and a corresponding radius r may be determined via any suitable methods.
- predetermined threshold temperatures may be determined via known experimental data, model equations, or combination thereof.
- one or more control algorithms for predicting tissue ablation size are employed by controller 300 .
- tissue temperature over time may be used to indicate tissue damage, e.g., death or necrosis.
- the control algorithm utilizes one or more model equations to calculate tissue damage that corresponds to tissue ablation zone size and temperature over time and at different energy levels.
- tissue damage e.g., death or necrosis.
- One suitable equation is the Arrhenius Equation, which may be represented by:
- ⁇ represents damage sustained by tissue and c(t)/c(0) is the ration of the concentration of a component of interest at time equal to the original concentration
- A is equal to the frequency factor
- E a activation energy
- T is temperature (in absolute temperature)
- R is the gas constant.
- the generator 200 includes a controller 300 including one or more modules (e.g., a temperature module 332 ), a power supply 237 , a microwave output stage 238 .
- generator 200 is described with respect to the delivery of microwave energy.
- the power supply 237 provides DC power to the microwave output stage 238 which then converts the DC power into microwave energy and delivers the microwave energy to the radiating section 138 of the microwave antenna 100 (see FIG. 2A ).
- the controller 300 may include analog and/or logic circuitry for processing sensed analog responses generated by the thermal sensors 136 and determining the control signals that are sent to the generator 200 and/or supply pump 40 via the microprocessor 335 .
- the controller 300 accepts one or more measurements signals indicative of a temperature associated with tissue adjacent an ablation zone and/or the microwave antenna 100 , namely, the signals generated as a result of the analog response produced by temperature sensors 136 .
- One or more modules e.g., temperature module 332 , of the controller 300 monitors and/or analyzes the analog response, e.g., a generated voltage, produced by the temperature sensors 136 and determines if a threshold temperature has been met. If the threshold temperature has been met, then the temperature module, a microprocessor 335 and/or the controller instructs the generator 200 to adjust the microwave output stage 238 and/or the power supply 237 accordingly.
- the controller 300 may also signal the supply pump to adjust the amount of cooling fluid to the microwave antenna 100 and/or the surrounding tissue.
- the controller 200 includes microprocessor 335 having memory 336 which may be volatile type memory (e.g., RAM) and/or non-volatile type memory (e.g., flash media, disk media, etc.).
- the microprocessor 335 is in operative communication with the power supply 237 and/or microwave output stage 238 allowing the microprocessor 335 to control the output of the generator 300 according to either open and/or closed control loop schemes.
- the microprocessor 335 is capable of executing software instructions for processing data received by the temperature module 332 , and for outputting control signals to the generator 300 and/or supply pump 40 , accordingly.
- the software instructions, which are executable by the controller 300 are stored in the memory 336 .
- the microwave antenna 100 of the present disclosure is configured to create an ablation zone “A” having any suitable configuration, such as, for example, spherical ( FIG. 3A ), hemispherical, ellipsoidal ( FIG. 3B where the ablation zone is designated “A- 2 ”), and so forth.
- microwave antenna 100 is configured to create an ablation zone “A” that is spherical ( FIG. 3A ).
- ablation zone “A” is being defined having a plurality of concentric ablation zones having radii r 1 -r 6 when measured from the center of the ablation zone “A,” collectively referred to as radii r.
- a measure of tissue temperature along any radius, e.g., r 3 , associated with ablation zone “A” indicates tissue temperature at similar radii about the entire ablation zone “A.”
- a control algorithm of the present disclosure uses known (or in certain instances predicted) temperatures at specific radii to created an ablation zone “A” having a radius r. That is, temperatures associated with a specific radius are compiled into one or more look-up tables “D” and are stored in memory, e.g., memory 336 , accessible by the microprocessor 335 and/or the temperature module 332 .
- the temperatures associated with a specific radius and/or one or more look-up tables “D” may be stored into memory during the manufacture process of the generator 200 , controller 300 or may be downloaded into memory 336 at a time prior to use of the system 10 .
- the analog response produced by one of the corresponding thermal sensors 136 e.g., thermal sensor 136 c , causes temperature module 332 to trigger a command signal to the controller 200 to adjust the power output accordingly.
- This combination of events will provide an ablation zone “A” with a radius approximately equal to r 3 .
- control algorithm, the microprocessor 335 and/or the temperature module 332 may utilize the above Arrhenius Equation to determine a specified amount of tissue damage, e.g., a threshold ⁇ (t), that correlates to ablation zone having a radius r. More particularly, for a given threshold ⁇ (t), a threshold temperature “T” may be determined and assigned a suitable voltage value that corresponds to a specific thermal sensor 136 , thermal sensor 136 c .
- the analog response produced by one of the corresponding thermal sensors 136 causes temperature module 332 to trigger a command signal to the controller 200 to adjust the power output accordingly.
- This combination of events will provide an ablation zone “A” with a radius approximately equal to r 3 .
- one or more control algorithms may utilize interpolation between the radii associated with the thermal sensors 136 to calculate temperatures between discreetly measured radii, e.g., temperatures measured between r 3 and r 4 . More particularly, various (and commonly known) interpolation techniques may be utilized via curve fitting along the thermal sensors 136 .
- Temperature module 332 is in operative communication with the plurality of sensors 136 strategically located for sensing various properties or conditions, e.g., tissue temperature, antenna temperature, etc. Temperature module 332 may be a separate module from the microprocessor 335 , or temperature module 332 may be included with the microprocessor 335 . In an embodiment, the temperature module 332 may be operably disposed on the microwave antenna 100 . The temperature module 332 may include control circuitry that receives information from the thermal sensors 136 , and provides the information and the source of the information (e.g., the particular temperature sensor, e.g., 136 c providing the information) to the controller 300 and/or microprocessor 335 .
- the particular temperature sensor e.g., 136 c providing the information
- the thermal module 332 , microprocessor 335 and/or controller 300 may access look-up table “D” and confirm that the threshold temperature at radius r 3 has been met and, subsequently instruct the generator 200 to adjust the amount of microwave energy being delivered to the microwave antenna.
- look-up table “D” may be stored in a memory storage device (not shown) associated with the microwave antenna 100 .
- a look-up table “D” may be stored in a memory storage device operatively associated with handle 118 and/or connector 126 of the microwave antenna 100 and may be downloaded, read and stored into microprocessor 335 and/or memory 336 and, subsequently, accessed and utilized in a manner described above; this would do away with reprogramming the generator 200 and/or controller 300 for a specific microwave antenna.
- the memory storage device may also be configured to include information pertaining to the microwave antenna 100 . Information, such as, for example, the type of microwave antenna, the type of tissue that the microwave antenna is configured to treat, the type of ablation zone desired, etc. may be stored into the storage device associated with the microwave antenna.
- generator 200 and/or controller 300 of system 10 may be adapted for use with a microwave antenna configured to create an ablation zone, e.g. ablation zone “A- 2 ,” different from that of microwave antenna 100 that is configured to create an ablation zone “A.”
- the generator is shown operably coupled to fluid supply pump 40 .
- the supply pump 40 is, in turn, operably coupled to the supply tank 44 .
- the microprocessor 335 is in operative communication with the supply pump 40 via one or more suitable types of interfaces, e.g., a port 240 operatively disposed on the generator 200 , which allows the microprocessor 335 to control the output of a cooling fluid 42 from the supply pump 40 to the microwave antenna 100 according to either open and/or closed control loop schemes.
- the controller 300 may signal the supply pump 40 to control the output of cooling fluid 42 from the supply tank 44 to the microwave antenna 100 . In this way, cooling fluid 42 is automatically circulated to the microwave antenna 100 and back to the supply pump 40 .
- a clinician may manually control the supply pump 40 to cause cooling fluid 42 to be expelled from the microwave antenna 100 into and/or proximate the surrounding tissue.
- microwave antenna 100 is connected to generator 200 .
- one or more modules, e.g., AZCM 332 , associated with the generator 200 and/or controller 300 reads and/or downloads data from a storage device associated with the antenna 100 , e.g., the type of microwave antenna, the type of tissue that is to be treated, etc.
- Microwave antenna 100 including thermal sensors 136 may then be positioned adjacent tissue ( FIG. 3A ).
- the generator 200 may be activated supplying microwave energy to the radiating section 138 of the microwave antenna 100 such that the tissue may be ablated.
- a corresponding thermal sensor e.g., thermal sensor 136 d
- the thermal sensor 136 and temperature module 332 function in real-time controlling the amount of microwave energy to the ablation zone such that a uniform ablation zone of suitable proportion is formed with minimal or no damage to adjacent tissue.
- a method 400 for monitoring temperature of tissue undergoing ablation is illustrated.
- microwave energy from a generator 200 is transmitted to a microwave antenna 100 adjacent a tissue ablation site.
- tissue temperature at the ablation site is monitored.
- a detection signal is triggered when a predetermined tissue temperature is reached at specific points along the microwave antenna.
- the amount of microwave energy from the generator 200 to the microwave antenna may be adjusted.
- the disclosed methods may be extended to other tissue effects and energy-based modalities including, but not limited to, ultrasonic and laser tissue treatments.
- the method 400 is based on temperature measurement and monitoring, but other tissue and energy properties may be used to determine state of the tissue, such as current, voltage, power, energy, phase of voltage and current.
- the method may be carried out using a feedback system incorporated into an electrosurgical system or may be a stand-alone modular embodiment (e.g., removable modular circuit configured to be electrically coupled to various components, such as a generator, of the electrosurgical system).
- thermal sensor 136 While system 10 has been described herein including individual thermal sensors 136 that correspond to a specific threshold tissue temperature, it is within the purview of the present disclosure that a single thermal sensor 136 may be configured to correspond to multiple threshold tissue temperatures that correspond to multiple radii. In this instance, the system 10 functions in substantially the same manner as described above.
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Abstract
Description
- 1. Technical Field
- The present disclosure relates to systems and methods that may be used in tissue ablation procedures. More particularly, the present disclosure relates to systems and methods for monitoring ablation size during tissue ablation procedures in real-time.
- 2. Background of Related Art
- In the treatment of diseases such as cancer, certain types of cancer cells have been found to denature at elevated temperatures (which are slightly lower than temperatures normally injurious to healthy cells). These types of treatments, known generally as hyperthermia therapy, typically utilize electromagnetic radiation to heat diseased cells to temperatures above 41° C. while maintaining adjacent healthy cells at lower temperatures where irreversible cell destruction will not occur. Procedures utilizing electromagnetic radiation to heat tissue may include ablation of the tissue.
- Microwave ablation procedures, e.g., such as those performed for menorrhagia, are typically done to ablate the targeted tissue to denature or kill the tissue. Many procedures and types of devices utilizing electromagnetic radiation therapy are known in the art. Such microwave therapy is typically used in the treatment of tissue and organs such as the prostate, heart, and liver.
- One non-invasive procedure generally involves the treatment of tissue (e.g., a tumor) underlying the skin via the use of microwave energy. The microwave energy is able to non-invasively penetrate the skin to reach the underlying tissue. However, this non-invasive procedure may result in the unwanted heating of healthy tissue. Thus, the non-invasive use of microwave energy requires a great deal of control.
- Currently, there are several types of systems and methods for monitoring ablation zone size. In certain instances, one or more types of sensors (or other suitable devices) are operably associated with the microwave ablation device. For example, in a microwave ablation device that includes a monopole antenna configuration, an elongated microwave conductor may be in operative communication with a sensor exposed at an end of the microwave conductor. This type of sensor is sometimes surrounded by a dielectric sleeve.
- Typically, the foregoing types of sensor(s) is configured to function (e.g., provide feedback to a controller for controlling the power output of a power source) when the microwave ablation device is inactive, i.e., not radiating. That is the foregoing sensors do not function in real-time. Typically, the power source is powered off or pulsed off when the sensors are providing feedback (e.g., tissue temperature) to the controller and/or other device(s) configured to control the power source.
- The present disclosure provides a system for monitoring ablation size in real-time. The system includes a power source including a microprocessor for executing at least one control algorithm. A microwave antenna is configured to deliver microwave energy from the power source to tissue to form an ablation zone. A series of thermal sensors is operably disposed adjacent a radiating section of the microwave antenna and extends proximally therefrom. The thermal sensors corresponding to a radius of the ablation zone, wherein each thermal sensor generates a voltage when a predetermined threshold tissue temperature is reached corresponding to the radius of the ablation zone.
- The present disclosure provides a microwave antenna adapted to connect to a power source configured for performing an ablation procedure. The microwave antenna includes a radiating section configured to deliver microwave energy from the power source to tissue to form an ablation zone. The microwave antenna includes a series of thermal sensors operably disposed adjacent the radiating section of the microwave antenna and extending proximally therefrom. The thermal sensors corresponding to a radius of the ablation zone, wherein each thermal sensor generates a voltage when a predetermined threshold tissue temperature is reached corresponding to the radius of the ablation zone.
- The present disclosure also provides a method for monitoring temperature of tissue undergoing ablation. The method includes the initial step of transmitting microwave energy from a power source to a microwave antenna to form a tissue ablation zone. A step of the method includes monitoring the proximal propagation of tissue temperature along the microwave antenna as the tissue ablation zone forms. Triggering a detection signal when a predetermined tissue temperature is reached at specific points along the microwave antenna is another step of the method. The method includes adjusting the amount of microwave energy from the power source to the microwave antenna.
- The above and other aspects, features, and advantages of the present disclosure will become more apparent in light of the following detailed description when taken in conjunction with the accompanying drawings in which:
-
FIG. 1A is a perspective view of a system for monitoring ablation size according to an embodiment of the present disclosure; -
FIG. 1B is a perspective view of a system for monitoring ablation size according to another embodiment of the present disclosure; -
FIG. 2A is partial side view of a distal tip of a microwave antenna depicted inFIG. 1A ; -
FIG. 2B is partial side view illustrating internal components associated with a distal tip of a microwave antenna according to an alternate embodiment of the present disclosure; -
FIG. 3A is a schematic, plan view of the tip of a microwave antenna depicted inFIG. 2A illustrating radial ablation zones having a spherical configuration; -
FIG. 3B is a schematic, plan view of the tip of a microwave antenna depicted inFIG. 2A illustrating radial ablation zones having an ellipsoidal configuration; -
FIG. 4 is a functional block diagram of a power source for use with the system depicted inFIG. 1A ; and -
FIG. 5 is a flow chart illustrating a method for monitoring temperature of tissue undergoing ablation in accordance with the present disclosure. - Embodiments of the presently disclosed system and method are described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical elements. As used herein and as is traditional, the term “distal” refers to the portion which is furthest from the user and the term “proximal” refers to the portion that is closest to the user. In addition, terms such as “above”, “below”, “forward”, “rearward”, etc. refer to the orientation of the figures or the direction of components and are simply used for convenience of description.
- Referring now to
FIG. 1A , a system for monitoring ablation size in accordance with an embodiment of the present disclosure is designated 10. Thesystem 10 includes amicrowave antenna 100 that is adapted to connect to an electrosurgical power source, e.g., an RF and/or microwave (MW)generator 200 that includes or is in operative communication with one ormore controllers 300 and, in some instances, afluid supply pump 40. Briefly,microwave antenna 100 includes anintroducer 116 having anelongated shaft 112 and a radiating or conductive section ortip 114 operably disposed withinelongated shaft 112, a coolingassembly 120 having a coolingsheath 121, ahandle 118, a coolingfluid supply 122 and a coolingfluid return 124, and anelectrosurgical energy connector 126.Connector 126 is configured to connect themicrowave antenna 100 to theelectrosurgical power source 200, e.g., a generator or source of radio frequency energy and/or microwave energy, and supplies electrosurgical energy to the distal portion of themicrowave antenna 100.Conductive tip 114 andelongated shaft 112 are in electrical communication withconnector 126 via an internalcoaxial cable 126 a that extends from the proximal end of themicrowave antenna 100 and includes an inner conductor tip that is operatively coupled to aradiating section 138 operably disposed within theshaft 112 and adjacent the conductive or radiating tip 114 (seeFIG. 2A , for example). As is common in the art, internalcoaxial cable 126 a includes a dielectric material and an outer conductor surrounding each of the inner conductor tip and dielectric material. A connection hub (not shown) disposed at a proximal end of themicrowave antenna 100operably couples connector 126 to internalcoaxial cable 126 a, and coolingfluid supply 122 and a coolingfluid return 124 to acooling assembly 120.Radiating section 138 by way of conductive tip 114 (or in certain instances without conductive tip 114) is configured to deliver radio frequency energy (in either a bipolar or monopolar mode) or microwave energy to a target tissue site.Elongated shaft 112 andconductive tip 114 may be formed of suitable conductive material including, but not limited to copper, gold, silver or other conductive metals having similar conductivity values. Alternatively,elongated shaft 112 and/orconductive tip 114 may be constructed from stainless steel or may be plated with other materials, e.g., other conductive materials, such as gold or silver, to improve certain properties, e.g., to improve conductivity, decrease energy loss, etc. In an embodiment, the conductive tip may be deployable from theelongated shaft 112. - In an alternate embodiment,
system 10 may be configured for use with amicrowave antenna 512 illustrated inFIG. 1A . Briefly,microwave antenna 512 operably couples togenerator 200 including acontroller 300 via a flexiblecoaxial cable 516. In this instance,generator 200 is configured to provide microwave energy at an operational frequency from about 500 MHz to about 10 GHz.Microwave antenna 512 includes a radiating section orportion 518 that may be connected by a feedline orshaft 520 tocoaxial cable 516 that extends from the proximal end of themicrowave antenna 512 and includes an inner conductor operably disposed within theshaft 520 andadjacent radiating section 518 and/or a conductive or radiatingtissue piercing tip 524. More specifically, themicrowave antenna 512 is coupled to thecable 516 through aconnection hub 522. Theconnection hub 522 also includes an outlet fluid port 530 (similar to that of cooling fluid return 124) and an inlet fluid port 532 (similar to that of cooling fluid supply 122) that are connected in fluid communication with asheath 538. Thesheath 538 encloses the radiatingportion 518 and theshaft 520 allowing for coolant fluid from theports antenna assembly 512 via respectivefluid lumens ports pump 40. For a more detailed description of themicrowave antenna 512 and operative components associated therewith, reference is made to commonly-owned U.S. patent application Ser. No. 12/401,268 filed on Mar. 10, 2009. - For the remainder of the disclosure the operative components associated with the
system 10 are described with reference tomicrowave antenna 100. - With reference now to
FIG. 2A , one or morethermal sensors 136 are operably disposed along a length of theshaft 112 adjacent aradiating section 138 of themicrowave antenna 100. In the embodiment illustrated inFIG. 2A ,thermal sensor 136 includes a series of six thermal sensors labeled 136 a-136 f (collectively referred to as thermal sensors 136). As defined herein, a series of thermal sensors is meant to mean at least two thermal sensors.Thermal sensors 136 enable physical space sampling of the ablation site.Thermal sensors 136 may be operably positioned within aninternal portion 150 of theshaft 112. More particularly, thethermal sensors 136 are operably disposed within an internal generallycircumferential wall 152 that surrounds and/or defines the cooling fluid supply andfluid return lines FIG. 2A , for example.Thermal sensors 136 may be secured to thecircumferential wall 152 via any suitable methods. In one particular embodiment, thethermal sensors 136 are secured to the circumferential wall via an epoxy adhesive. In an alternate embodiment, a plastic (or other suitable structure) provides mechanical fixation points for thethermal sensors 136. In this instance, the plastic structure (e.g., a circumferential or spiral plastic structure) may be operably disposed within theshaft 112 and couple to one or both of the fluid paths, e.g., supply fluid and returnpaths Thermal sensors 136 may be disposed along the length of theshaft 112 in any suitable configuration. For example, in the embodiment illustrated inFIG. 2A ,thermal sensors 136 are positioned along the shaft 110 in a linear manner forming a generally linear array alongcircumferential wall 152 of theshaft 112. Alternatively, thethermal sensors 136 may be positioned alongcircumferential wall 152 of theshaft 112 in a radially offset configuration forming a generally spherical or spiral array (FIG. 2B ).Thermal sensors 136 may be any suitablethermal sensors 136 including but not limited to thermistors, thermocouples, fiber optic sensors, or other device suitable for the intended purpose for monitoring temperature. In the embodiment illustrated inFIGS. 2A and 3A , thethermal sensors 136 are sixthermocouples 136 a-136 f.Thermal sensors 136 are in operative communication with atemperature module 332 and/orcontroller 300. More particularly, thethermal sensors 136 couple to thegenerator 200 and/orcontroller 300 via one or more leads, e.g., theinternal cable 126 a that extends from the proximal end of themicrowave antenna 100 and connects to theport 126. In embodiments, thethermal sensors 136 may be in operative communication with thegenerator 200 and/orcontroller 300 by way of a wireless connection.Thermal sensors 136 are configured to provide comprehensive monitoring of an ablation zone “A” (FIG. 3A ). Thethermal sensors 136 are configured to generate an analog response (e.g., a voltage, resistance, current, etc.) when a predetermined threshold temperature is reached within the ablation zone “A.” More particularly, an initial voltage potential is generated by each of thethermal sensors 136 during transmission of electrosurgical energy from thegenerator 200 to themicrowave antenna 100. A predetermined threshold voltage potential is associated with each ofthermal sensors 136 and corresponds to a predetermined threshold tissue temperature along a radius of an ablation zone (FIG. 3A ). For example,thermal sensor 136 a may be configured to generate an initial voltage potential of 1 volt and a predetermined threshold voltage of 2 volts that corresponds to a threshold tissue temperature of 60° Celsius that corresponds to an ablation zone “A” having a radius r1. The analog response, e.g., voltage, indicates totemperature module 332 that a predetermined threshold temperature is reached at the ablation zone (described in more detail below). More particularly,temperature module 332 monitors thethermal sensors 136, e.g., monitors voltage of thethermal sensors 136, and triggers a command signal in response to thethermal sensors 136 reaching a predetermined voltage such that the electrosurgical output power from thegenerator 200 may be adjusted. In an embodiment, an amplifier (not shown) may be utilized to amplify the voltage potential generated by thethermal sensors 136. - For a given
microwave antenna 100, each of thethermal sensors 136 may be configured to generate an analog response, e.g., a predetermined voltage, when a predetermined threshold temperature, e.g., a threshold temperature approximately equal to 60° Celsius, has been met such that an ablation zone “A” having a radius r is created. The predetermined threshold temperature associated with a correspondingthermal sensor 136 and a corresponding radius r may be determined via any suitable methods. For example, predetermined threshold temperatures may be determined via known experimental data, model equations, or combination thereof. In one particular embodiment, one or more control algorithms for predicting tissue ablation size are employed bycontroller 300. More particularly, the concept of the integration of tissue temperature over time may be used to indicate tissue damage, e.g., death or necrosis. The control algorithm utilizes one or more model equations to calculate tissue damage that corresponds to tissue ablation zone size and temperature over time and at different energy levels. One suitable equation is the Arrhenius Equation, which may be represented by: -
- where Ω represents damage sustained by tissue and c(t)/c(0) is the ration of the concentration of a component of interest at time equal to the original concentration, A is equal to the frequency factor, Ea is activation energy, T is temperature (in absolute temperature), and R is the gas constant. Thus, for a given amount of tissue damage (which correlates to ablation zone having a radius r) a corresponding value of tissue temperature can be determined. The Arrhenius Equation is one of many equations that may be employed to calculate and predict tissue temperature over time and at different energy fields such that real-time monitoring of an ablation zone may be achieved.
- With reference to
FIG. 4 , a schematic block diagram of thegenerator 200 is illustrated. Thegenerator 200 includes acontroller 300 including one or more modules (e.g., a temperature module 332), apower supply 237, amicrowave output stage 238. In this instance,generator 200 is described with respect to the delivery of microwave energy. Thepower supply 237 provides DC power to themicrowave output stage 238 which then converts the DC power into microwave energy and delivers the microwave energy to theradiating section 138 of the microwave antenna 100 (seeFIG. 2A ). Thecontroller 300 may include analog and/or logic circuitry for processing sensed analog responses generated by thethermal sensors 136 and determining the control signals that are sent to thegenerator 200 and/orsupply pump 40 via themicroprocessor 335. Thecontroller 300 accepts one or more measurements signals indicative of a temperature associated with tissue adjacent an ablation zone and/or themicrowave antenna 100, namely, the signals generated as a result of the analog response produced bytemperature sensors 136. One or more modules e.g.,temperature module 332, of thecontroller 300 monitors and/or analyzes the analog response, e.g., a generated voltage, produced by thetemperature sensors 136 and determines if a threshold temperature has been met. If the threshold temperature has been met, then the temperature module, amicroprocessor 335 and/or the controller instructs thegenerator 200 to adjust themicrowave output stage 238 and/or thepower supply 237 accordingly. Additionally, thecontroller 300 may also signal the supply pump to adjust the amount of cooling fluid to themicrowave antenna 100 and/or the surrounding tissue. Thecontroller 200 includesmicroprocessor 335 havingmemory 336 which may be volatile type memory (e.g., RAM) and/or non-volatile type memory (e.g., flash media, disk media, etc.). In the illustrated embodiment, themicroprocessor 335 is in operative communication with thepower supply 237 and/ormicrowave output stage 238 allowing themicroprocessor 335 to control the output of thegenerator 300 according to either open and/or closed control loop schemes. Themicroprocessor 335 is capable of executing software instructions for processing data received by thetemperature module 332, and for outputting control signals to thegenerator 300 and/orsupply pump 40, accordingly. The software instructions, which are executable by thecontroller 300, are stored in thememory 336. - The
microwave antenna 100 of the present disclosure is configured to create an ablation zone “A” having any suitable configuration, such as, for example, spherical (FIG. 3A ), hemispherical, ellipsoidal (FIG. 3B where the ablation zone is designated “A-2”), and so forth. In one particular embodiment,microwave antenna 100 is configured to create an ablation zone “A” that is spherical (FIG. 3A ). To facilitate understanding of the present disclosure, ablation zone “A” is being defined having a plurality of concentric ablation zones having radii r1-r6 when measured from the center of the ablation zone “A,” collectively referred to as radii r. A measure of tissue temperature along any radius, e.g., r3, associated with ablation zone “A” indicates tissue temperature at similar radii about the entire ablation zone “A.” In one embodiment, a control algorithm of the present disclosure uses known (or in certain instances predicted) temperatures at specific radii to created an ablation zone “A” having a radius r. That is, temperatures associated with a specific radius are compiled into one or more look-up tables “D” and are stored in memory, e.g.,memory 336, accessible by themicroprocessor 335 and/or thetemperature module 332. The temperatures associated with a specific radius and/or one or more look-up tables “D” may be stored into memory during the manufacture process of thegenerator 200,controller 300 or may be downloaded intomemory 336 at a time prior to use of thesystem 10. When a temperature of the ablation zone “A” reaches a predetermined threshold temperature, the analog response produced by one of the correspondingthermal sensors 136, e.g.,thermal sensor 136 c, causestemperature module 332 to trigger a command signal to thecontroller 200 to adjust the power output accordingly. This combination of events will provide an ablation zone “A” with a radius approximately equal to r3. Alternatively, or in combination therewith, the control algorithm, themicroprocessor 335 and/or thetemperature module 332 may utilize the above Arrhenius Equation to determine a specified amount of tissue damage, e.g., a threshold Ω(t), that correlates to ablation zone having a radius r. More particularly, for a given threshold Ω(t), a threshold temperature “T” may be determined and assigned a suitable voltage value that corresponds to a specificthermal sensor 136,thermal sensor 136 c. In this instance, when a temperature of the ablation zone “A” reaches a predetermined threshold temperature, the analog response produced by one of the correspondingthermal sensors 136, e.g.,thermal sensor 136 c, causestemperature module 332 to trigger a command signal to thecontroller 200 to adjust the power output accordingly. This combination of events will provide an ablation zone “A” with a radius approximately equal to r3. In embodiments, one or more control algorithms may utilize interpolation between the radii associated with thethermal sensors 136 to calculate temperatures between discreetly measured radii, e.g., temperatures measured between r3 and r4. More particularly, various (and commonly known) interpolation techniques may be utilized via curve fitting along thethermal sensors 136. -
Temperature module 332 is in operative communication with the plurality ofsensors 136 strategically located for sensing various properties or conditions, e.g., tissue temperature, antenna temperature, etc.Temperature module 332 may be a separate module from themicroprocessor 335, ortemperature module 332 may be included with themicroprocessor 335. In an embodiment, thetemperature module 332 may be operably disposed on themicrowave antenna 100. Thetemperature module 332 may include control circuitry that receives information from thethermal sensors 136, and provides the information and the source of the information (e.g., the particular temperature sensor, e.g., 136 c providing the information) to thecontroller 300 and/ormicroprocessor 335. In this instance, thethermal module 332,microprocessor 335 and/orcontroller 300 may access look-up table “D” and confirm that the threshold temperature at radius r3 has been met and, subsequently instruct thegenerator 200 to adjust the amount of microwave energy being delivered to the microwave antenna. In one particular embodiment, look-up table “D” may be stored in a memory storage device (not shown) associated with themicrowave antenna 100. More particularly, a look-up table “D” may be stored in a memory storage device operatively associated withhandle 118 and/orconnector 126 of themicrowave antenna 100 and may be downloaded, read and stored intomicroprocessor 335 and/ormemory 336 and, subsequently, accessed and utilized in a manner described above; this would do away with reprogramming thegenerator 200 and/orcontroller 300 for a specific microwave antenna. The memory storage device may also be configured to include information pertaining to themicrowave antenna 100. Information, such as, for example, the type of microwave antenna, the type of tissue that the microwave antenna is configured to treat, the type of ablation zone desired, etc. may be stored into the storage device associated with the microwave antenna. In this instance, for example,generator 200 and/orcontroller 300 ofsystem 10 may be adapted for use with a microwave antenna configured to create an ablation zone, e.g. ablation zone “A-2,” different from that ofmicrowave antenna 100 that is configured to create an ablation zone “A.” - In the embodiment illustrated in
FIG. 1A , the generator is shown operably coupled tofluid supply pump 40. Thesupply pump 40 is, in turn, operably coupled to thesupply tank 44. In embodiments, themicroprocessor 335 is in operative communication with thesupply pump 40 via one or more suitable types of interfaces, e.g., aport 240 operatively disposed on thegenerator 200, which allows themicroprocessor 335 to control the output of a coolingfluid 42 from thesupply pump 40 to themicrowave antenna 100 according to either open and/or closed control loop schemes. Thecontroller 300 may signal thesupply pump 40 to control the output of cooling fluid 42 from thesupply tank 44 to themicrowave antenna 100. In this way, coolingfluid 42 is automatically circulated to themicrowave antenna 100 and back to thesupply pump 40. In certain embodiments, a clinician may manually control thesupply pump 40 to cause coolingfluid 42 to be expelled from themicrowave antenna 100 into and/or proximate the surrounding tissue. - Operation of
system 10 is now described. Initially,microwave antenna 100 is connected togenerator 200. In one particular embodiment, one or more modules, e.g.,AZCM 332, associated with thegenerator 200 and/orcontroller 300 reads and/or downloads data from a storage device associated with theantenna 100, e.g., the type of microwave antenna, the type of tissue that is to be treated, etc.Microwave antenna 100 includingthermal sensors 136 may then be positioned adjacent tissue (FIG. 3A ). Thereafter, thegenerator 200 may be activated supplying microwave energy to theradiating section 138 of themicrowave antenna 100 such that the tissue may be ablated. During tissue ablation, when a predetermined threshold temperature is reached (such as the temperature that corresponds to radius r4) a corresponding thermal sensor e.g.,thermal sensor 136 d, generates a voltage potential that is detected by thetemperature module 332, which, in turn, instructs thegenerator 200 to adjust the microwave energy accordingly. In the foregoing sequence of events, thethermal sensor 136 andtemperature module 332 function in real-time controlling the amount of microwave energy to the ablation zone such that a uniform ablation zone of suitable proportion is formed with minimal or no damage to adjacent tissue. - With reference to
FIG. 5 amethod 400 for monitoring temperature of tissue undergoing ablation is illustrated. Atstep 402, microwave energy from agenerator 200 is transmitted to amicrowave antenna 100 adjacent a tissue ablation site. At step, 404, tissue temperature at the ablation site is monitored. Atstep 406, a detection signal is triggered when a predetermined tissue temperature is reached at specific points along the microwave antenna. Atstep 408, the amount of microwave energy from thegenerator 200 to the microwave antenna may be adjusted. - From the foregoing and with reference to the various figure drawings, those skilled in the art will appreciate that certain modifications can also be made to the present disclosure without departing from the scope of the same. For example, in some embodiments, the disclosed methods may be extended to other tissue effects and energy-based modalities including, but not limited to, ultrasonic and laser tissue treatments. The
method 400 is based on temperature measurement and monitoring, but other tissue and energy properties may be used to determine state of the tissue, such as current, voltage, power, energy, phase of voltage and current. In some embodiments, the method may be carried out using a feedback system incorporated into an electrosurgical system or may be a stand-alone modular embodiment (e.g., removable modular circuit configured to be electrically coupled to various components, such as a generator, of the electrosurgical system). - While
system 10 has been described herein including individualthermal sensors 136 that correspond to a specific threshold tissue temperature, it is within the purview of the present disclosure that a singlethermal sensor 136 may be configured to correspond to multiple threshold tissue temperatures that correspond to multiple radii. In this instance, thesystem 10 functions in substantially the same manner as described above. - While several embodiments of the disclosure have been shown in the drawings and/or discussed herein, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
Claims (18)
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JP2011039355A JP2011189122A (en) | 2010-02-25 | 2011-02-25 | System and method for monitoring ablation size |
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